A 45-year-old man presents with sudden severe headache, bilateral vision loss, and hypotension. He has a known pituitary macroadenoma. MRI shows hemorrhage within the pituitary mass with suprasellar extension compressing the optic chiasm. What is the immediate management priority?
- A Urgent transsphenoidal surgical decompression
- B Bromocriptine therapy
- C High-dose glucocorticoid replacement ✓
- D Emergency external ventricular drainage
Correct answer: C. High-dose glucocorticoid replacement
Explanation
Pituitary apoplexy is a neurosurgical emergency characterized by hemorrhage or infarction in a pituitary adenoma. The immediate priority is high-dose glucocorticoid replacement (intravenous hydrocortisone) because acute adrenal insufficiency is life-threatening. Once stabilized, transsphenoidal decompression is indicated for severe visual deterioration or altered consciousness. Bromocriptine may be used for prolactinomas but is not the immediate priority.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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Written and medically reviewed by the StethoPrep medical team.